Exam 2 - Renal, Muskoskeletal (Respiratory & Fluid & Electrolytes)

Vitamin B: Normal Cobalamin

200-835 pg/mL

Hemodialysis: What action the nurse should take prior to the patient's scheduled hemodialysis treatment?

A baseline weight must be obtained to be able to determine the net fluid loss from dialysis

Renal: What is pyelonephritis?

A diffuse, pyogenic infection of the pelvis and parenchyma of the kidney that causes flank pain, chills, fever and weakness

Peritoneal Dialysis: The reason dialysis solution is warmed before it is instilled?

A warm temperature encourages the removal of serum urea by preventing constriction of peritoneal blood vessels so that urea, a large-molecular substance, is shifted from the body into the dialyzing solution

Renal: What is cytitis?

An inflammation of the bladder that cause frequency, hematuria, urgency, and pain on urination

Medication: What to monitor for in a client who is prescribed any type of antihypertensive medication (-pril)?

Antihypertensive helps with lowering BP which reflects a therapeutic's response and it needs to be monitored regularly

Peritoneal Dialysis: Potentian Complications of Peritoneal Dialysis

Bacterial peritonitis - hence, sterile technique when spiking or changing the bags of dialysate

Renal: Pathophysiology of Renal Calculi

Calcium that has left the bones as a resposne to prolonged inactivity enters the blood and precipitate in the kidneys, forming calculi

Fat Embolism: Early Sign of Fat Embolism

Confusion then petetchiae on the neck and chest

Nephrectomy: Complication during the Client's Early Postoperative Period After a Radical Nephrectomy

Hemorrhage - the kidney is an extreme vascular organ which receives large percentage of blood flow

Renal: Complication to monitor in a client receiving dialysis?

Hepatitis B (transmitted by blood or blood products)

Rheumatoid Arthritis: A client taking ibuprofen for rheumatoid arthritis who asks the nurse if acetaminophen can be substituted?

Ibuprofen has an anti-inflammatory action that relieves the inflammation and pain associated with arthritis; acetaminophen is non an NSAID

Renal: Vitamin D activation and how it is related to renal failure

In renal failure, there is ↓ in the active metabolite of vitamin D because inactive vitamin D gets activated in the liver and then in the kidneys

Renal: Why metabolic acidosis develops with kidney failure?

Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate

Renal: Intervention that prevent urinary stasis and formation of renal calculi in immobile client

Increasing oral fluid intake 2-3 L/day, if not contraindicated, will dilute urine and promote urine flow

Renal: Furosemide

Inhibits sodium and chloride absorption from the ascending loop of Henle, proximal tubules & distal tubules

Endocrine: Insulin to use for emergency treatment of ketoacidosis

Insulin aspart (rapid-acting insulin) is used to meet client's immediate insulin needs

Renal: Best position for a client who is recovering from an ORIF of a fractured hip?

Moderate abduction Rationale: Abduction reduces stress on anatomic structures and maintains the head of the femur in the acetabulum

Renal: Which finding is expected in a client diagnosed with early glomerulonephritis?

Protein in the urine (proteinuria) and hematuria (blood in the urine) are classical manifestations of the onset of glomerulonephritis because of the permeability of the vascular bed in the kidneys

Respiratory Distress: Finding in A Client Experiencing Severe Acute Respiratory Distress

Tachycardia & Tachypnea

RA or OA: Heberden nodules?

The bony or cartilaginous enlargements of the distal interphalangeal joints that are associated with osteoarthritis (OA)

Nursing Process: Nursing Diagnosis

The nursing diagnosis should lead to etiology-specific interventions and enhanced client outcomes

Renal: A protein-restricted dietary change required for AKI

This diet supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys

Renal: What are nursing interventions in the plan of care of a client with kidney dysfunction who is about to undergo renal testing using a contrast medium?

→ Assess the client for a Hx of cirrhosis → Asking the client about shellfish allergies → Discontinue metformin 48 hours from the time of contrast medium administration → Evaluate the client's hydration status & respiratory rates

Glomerulonephritis: Nursing Interventions

→ Monitor fluid status VERY closely → Daily weights - use the same standing scale → Strict I/O → If Oliguric (low urinary output) watch for hyperkalemia WHY? When the GFR is decreased, potassium is not excreted properly which leads to hyperkalemia → Assess for urine color → Assess swelling status → Monitor lung sounds for crackles...signs of pulmonary edema → Monitor BUN and Creatinine levels ....renal failure → Monitor vital signs ESPECIALLY blood pressure → Sodium restriction along with fluid restriction diet

Glomerulonephritis: Pathophysiology

→ The inflammation of the filtering structure of the nephron (what is the filtering structure of the nephron? Glomerulus) that causes permeability to protein and red blood cells due to previous strep infection → Therefore, protein and red blood cells will be present in the urine → The immune system's response to the bacteria by creating antigen-antibody complexes, which inflames the glomerulus

Renal: Serum Creatinine

▪︎ A test of renal function; measures the kidney's ability to excrete metabolic wastes; ▪︎ In renal insufficiency, creatinine is elevated

Osteomyelitis: Hyperbaric Oxygen Therapy

▪︎ Administration of oxygen under pressure, raising the tissue's oxygen concentrations ▪︎ Used for burns, osteomyelitis, and diabetic ulcers

Peritonitis: What is (are) the most likely the cause(s) of peritonitis in the client's medical history?

▪︎ Bowel obstruction ▪︎ Appendicitis ▪︎ External penetrating wound ▪︎ Peritoneal dialysis

Buck Traction: Appropriate Actions for a Client in Buck's Skin Traction

▪︎ Client should be in a supine position or in Semi-Fowler's position (maximum of 20-30 deg) ▪︎ Regularly assess the neurovascular strap and skin integrity of the limb; when a change made to the velcro strap, the nurse should reassess the neurovascular status in 30 minutes ▪︎ Weights should be free-hanging at all times and should never be placed onto bed or touch the floor ▪︎ Weights should never be removed unless there is life-threatening situation

Renal: Assessment of Acute Glomerulonephritis (What would you expect to find in a child?)

▪︎ Flank pain is caused by inflammatory and degenerative changes in renal tissue; antigen-antibody complex becomes trapped in the glomeruli ▪︎ Decreased filtration leads to accumulation and sodium retention; hence, preorbital edema

Renal: Buck's traction application (How to apply it correctly?)

▪︎ Hang the weight to apply traction, but limit it to 10 lbs (4.5 kg) ▪︎ Spreader bar should be wide enough to keep materials away from the malleoli ▪︎ Buck boot should extend to the area just below the knee ▪︎ Tape is not necessary

Glomerulonephritis: Signs and Symptoms

▪︎ Hypertension ▪︎ ASO antistreptolysin titer positive (test used to diagnose strep infections) ▪︎ Decreased GFR (low urine output) ▪︎ Swelling in face/eyes (edema)...mild ▪︎ Tea-colored urine (cola colored)...from hematuria ▪︎ Recent strep infection ▪︎ Elevated BUN and creatinine ▪︎ Proteinuria (mild)

Renal: In a client with diagnosis of end-stage renal disease, what aboratory results would the nurse anticipate?

▪︎ Impaired potassium excretion → hyperkalemia Normal range: 3.5-5.0 mEq ▪︎ Metabolic acidosis → pH < 7.35 ▪︎ ↓ erythropoietin → ↓ hematocrit ▪︎ ↑ Cr → > 1.2

CBI: Care of the Patient w/ Continuous Bladder Irrigation

▪︎ Physician will remove post-op day 1 or 2 depending on the urine color ▪︎ Bright red blood initially then it should start to become PINK ▪︎ If theres blood clots after the urine was pink there is a PROBLEM

Peritoneal Dialysis: What action would the nurse take when a client receiving peritoneal dialysis develops symptoms of severe respiratory difficulty during the infusion of the dialysate solution?

▪︎ Pressure from the fluid may cause upward displacement of the diaphragm ▪︎ Draining the solution reduces intra-abdominal pressure - allows the thoracic cavity to expand on inspiration

CBI: Complications that Nurses Are Worrying About?

▪︎ Problems controlling bowel movements (bowel incontinence) ▪︎ Problems controlling urine (urinary incontinence) ▪︎ Erection problems (impotence) ▪︎ Injury to the rectum ▪︎ Urethral stricture (tightening of the urinary opening due to scar tissue)

Renal: The role of erythropoietin

▪︎ Produced by the kidneys ▪︎ Stimulates the bone marrow to produce RBCs In renal failure, there is a deficiency of erythropoietin that results in the client developing anemia

Hemodialysis: Dialysis Disequilibrium Syndrome (DDS)

▪︎ Rare, but potentially life-threatening ▪︎ Occurs when solutes are removed more quickly from blood than from brain cells and CSF ▪︎ This concentration gradient can lead to cerebral edema ▪︎ Can be prevent by slowing the rate of HD ▪︎ SxS: nausea, vomiting, HA, restlessness, N/V, chest pain

Renal: Interventions for client undergoes renal scan

▪︎ Renal scan purpose: examine the structure, function and perfusion of the kidneys using the IV radioisotope ▪︎ Fasting is not required before procedure ▪︎ Furosemide should be administered after initial imaging to visualize the area

Pyelonephritis: Acute Pyelonephritis

▪︎ Result from bacterial infection, with/without obstruction or reflux (commonly bacteria: E.coli) ▪︎ Acute tissue inflammation, local edema, tubular cell necrosis, and possible abscess formation

Glomerulonephritis: Preventive Measure for Glomerulonephritis

▪︎ Seek early treatment for respiratory infections ▪︎ Streptococcal infection can trigger antibody formation that damages the glomeruli

Anemia: Manifestations of Pernicious Anemia

▪︎ Shiny tongue ▪︎ Paresthesias of the limbs ▪︎ Ataxia ▪︎ Low cobalamin Vitamin B12 cannot be given orally - doesn't have intrinsic factor

Peritoneal Dialysis: Potential complications of a client receiving continuous ambulatory peritoneal dialysis

▪︎ Tachycardia - HR ↑ r/t to infection ▪︎ Cloudy outflow - or opaque dialysate outflow ▪︎ Abdominal pain - results from peritoneal inflammation, abdominal distention & involuntary muscle spasms

Osteomyelitis: Clinical Manifestations of Osteomyelitis

▪︎ Temperature above 101 F [38.3 C] ▪︎ Erythema around the affected area ▪︎ Tenderness around the affected area

Renal: How to determine if the AV fistula is patent prior hemodialysis?

▪︎ The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit ▪︎ The presence of a thrill and bruit indicate patency of the fistula

Buck Traction: The purpose of buck traction

▪︎ To immoblize the fracture prior to surgery - a continuous pull on the lower extremity keeps bone fragments from moving and causing further trauma, pain & edema ▪︎ To relieve muscle spasm and pain

Rheumatoid Arthritis: Common deformity of occur with RA

▪︎ Ulnar drift ▪︎ Swan-neck deformity ▪︎ Boutonniere deformity

Renal: The goal of continuous ambulatory peritoneal dialysis (CAPD)

▪︎ Uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion ▪︎ Diffusion - moves particles from greater concentration to lesser concentration ▪︎ Osmosis - moves particles from lesser gradient to greater gradient

Peritoneal Dialysis: Patient Education on How to Prevent Peritoneal Dialyisis

▪︎ Wear a mask during the procedure ▪︎ Clean the cather exit site every day ▪︎ Maintain meticulous aseptic technique ▪︎ Wash your hands before the exchange ▪︎ Store supplies in clean & dry location Remember: the location of the peritoneal dialysis catheter makes it direct portal to the peritoneum